Abstract
BackgroundAcute mural dissection of the anterior wall of the internal carotid artery which may contribute to the development of blood blister-like aneurysms (BBLAs) was postulated, and stenting or flow diversion treatment across the soi-disant aneurysm was reported in this study.MethodsFrom December 2016 to December 2018, 8 patients presenting with subarachnoid hemorrhage (SAH) due to BBLA were subjected to endovascular treatment with stent-assisted coiling. Clinical outcomes were evaluated using a clinical outcome score scale.ResultsBased on angiograms, pathologic change involving the supraclinoid segments of the internal carotid artery (ICA) adjacent to BBLA was found in all patients. This pathologic change meant a focal dissection of the supraclinoid segment of the ICA which constituted the pathogenesis of BBLAs. Closed-cell, open-cell, and braided stents were used in 1, 1, and 6 patients, respectively. Complete obliteration was achieved following endovascular treatment among all 8 patients harboring BBLA. One re-bleeding successive to a closed-cell stent across the aneurysmal neck was observed. Follow-up angiograms revealed stable complete exclusion of all BBLAs from the parent vessel at 3 to 8 months. All patients had a favorable clinical outcome score of 0–1.ConclusionsAcute dissection of a focal point of the intracranial vessels underlies the development of BBLAs. Open-cell and braided-cell stent-assisted coiling may constitute appropriate treatment due to good apposition against the vascular walls. Adjunctive coils may facilitate immediate complete occlusion of BBLAs.
Highlights
Acute mural dissection of the anterior wall of the internal carotid artery which may contribute to the development of blood blister-like aneurysms (BBLAs) was postulated, and stenting or flow diversion treatment across the soi-disant aneurysm was reported in this study
The rarity of BBLA encouraged our collaborative determination to conduct a review of radiograms, demographics, presenting sets of symptomatology and signs, treatment approaches, and clinical outcomes of a cohort possessing the identical pathology subjected to endovascular treatment
All BBLAs among our patients involved the supraclinoid segments of internal carotid artery (ICA) and were attended by luminal change
Summary
Acute mural dissection of the anterior wall of the internal carotid artery which may contribute to the development of blood blister-like aneurysms (BBLAs) was postulated, and stenting or flow diversion treatment across the soi-disant aneurysm was reported in this study. Focal protrusions of the neurovascular arterial intima and/or media through the arterial adventitia constitute soi-disant blood blister-like aneurysms (BBLAs). Hypertension, younger age, and origin from the right side of the ICA may constitute demographic and pathologic properties conspiring to enhance the risk of developing BBLA [5]. Developing a more intimate and nuanced understanding of the mechanisms underlying the pathogenesis of soi-disant BBLA will enhance our capacity to manage and prevent re-bleeding and regrowth of these lesions to the end of maximally annihilating lesional rupture and optimizing “patient-al” neurological outcome. The rarity of BBLA encouraged our collaborative determination to conduct a review of radiograms, demographics, presenting sets of symptomatology and signs, treatment approaches, and clinical outcomes of a cohort possessing the identical pathology subjected to endovascular treatment
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